Although cerebrospinal fluid (CSF) shunting is the most common neurosurgical treatment
for hydrocephalus, the long-term results have still been unsatisfactory because of
a wide variety of shunt complications. We have recently developed flexible ventriculoscopes
(Yamadori-type) which have excellent image quality, maneuverability, and capabilities
for endoscopic operation. Here we report the efficacy of the new treatment in 88 children
with hydrocephalus who initially underwent either ventriculoscopic operation or shunting
surgery. The primary outcome measures were the rate of shunt independency and/or shunt
complications with a follow-up of 2 years in each group. We performed endoscopic third
ventriculostomy in cases of aqueductal stenosis, cyst fenestration, and choroid plexus
coagulation in limited cases of communicating hydrocephalus. Overall, thirty-three
(75 %) of the 44 children initially treated endoscopically did not require ventriculoperitoneal
(VP) shunts. The endoscopic procedures were repeated in the remaining 11 children
(25 %) mostly less than 1-year-old who ultimately required endoscope-guided VP shunting.
Even in such patients, there was virtually no need for shunt revisions and no major
complications such as slit-like ventricle, meningitis, and intraventricular hemorrhage.
These results were statistically highly significant (p < 0.0001) compared to a control
group of 44 patients treated initially by VP shunting. Our data demonstrate that therapeutic
ventriculoscopy is safe and clinically effective as the first-line treatment of hydrocephalus
in children.
Key words:
Pediatric hydrocephalus - Therapeutic ventriculoscope - Shunt independence - Shunt
complications - Third ventriculostomy
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Corresponding Author
A Inui,M. D., Ph. D
Second Department of Internal Medicine
Kobe University School of Medicine
7-5-2, Kusunoki-cho, Chuo-ku Kobe 650-0017
Japan
Phone: Phone: +81-78-382-5862
Fax: Fax: +81-78-382-2080
Email: E-mail: inui@med.kobe-u.ac.jp
